title: Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data.
abstract: BACKGROUND
  Approximately 30-80% of postoperative patients complain about moderate to severe post-surgical pain, indicating that postoperative pain treatment is still a problem.
  
  
  METHODS
  We analysed prospectively collected data on patients in a university hospital receiving systemic and epidural patient-controlled analgesia and continuous peripheral nerve block (CPNB) documented by the acute pain service team in a computer-based system.
  
  
  RESULTS
  Of 18 925 patients visited in the postoperative period between 1998 and 2006, 14 223 patients received patient-controlled epidural analgesia (PCEA), 1591 i.v. patient-controlled analgesia (IV-PCA), 1737 continuous brachial plexus block, and 1374 continuous femoral/sciatic nerve block. Mean dynamic and resting pain scores (VAS 0-100) were significantly lower for peripheral or neuroaxial regional analgesia compared with patient-controlled systemic opioid analgesia (P<0.05). The risk of a symptomatic spinal mass lesion including epidural haematoma (0.02%; 1:4741) or epidural abscess (0.014%; 1:7142) after PCEA was 1:2857 (0.04%). Neurological complications after CPNB occurred in two patients who received interscalene brachial plexus block.
  
  
  CONCLUSIONS
  We demonstrated that PCEA, IV-PCA, and CPNB are safe and efficient. Although all of these treatment strategies provide effective analgesia, PCEA and CPNB provided superior pain relief compared with IV-PCA. We demonstrated that serious complications of analgesic techniques are rare but possibly disastrous necessitating a close supervision by an acute pain service. We found a low rate of adverse effects including hypotension and motor impairment and a low incidence of epidural haematoma for thoracic PCEA compared with lumbar PCEA.
authors.affiliation: Department of Anaesthesiology and Intensive Care, University Hospital Münster, D-48149 Münster, Germany. poppind@uni-muenster.de
authors.forename: D M
authors.initials: DM
authors.lastname: Pöpping
authors.forename: P K
authors.initials: PK
authors.lastname: Zahn
authors.forename: H K
authors.initials: HK
authors.lastname: Van Aken
authors.forename: B
authors.initials: B
authors.lastname: Dasch
authors.forename: R
authors.initials: R
authors.lastname: Boche
authors.forename: E M
authors.initials: EM
authors.lastname: Pogatzki-Zahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D002406:Catheterization, Peripheral / Q000009:adverse effects; D020802:Epidural Abscess / Q000209:etiology; D005260:Female; D005858:Germany; D046748:Hematoma, Epidural, Spinal / Q000209:etiology; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D018710:Pain Clinics / Q000592:standards / Q000706:statistics & numerical data; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control* / Q000523:psychology; D017060:Patient Satisfaction; D011446:Prospective Studies; D011787:Quality of Health Care; D016896:Treatment Outcome